A Clinical Review of Gallbladder and Biliary Tract Stones

Cho, Kyu Nam; Kim, Jae Man

Abstract

In Korea, the incidence and modality of gallstones have changed, since meal have become westernized and the socioeconomic state has improved. Choledocholithiasis, which has a high incidence rate in Koreans is difficulty to treat as a result of retained stones. This report deals with a clinical analysis of recent trends in gallstone disease and approaches to ideal method of treatment. A retrospective analysis was done on 192 gallstone patients who had undergone an operations at the Department of Surgery, Seoul Red Cross Hospital, from January 1992 to December 1996. The results are as follows: 1) The male to female ratio was 1:1.7, and the most common age group was the 6th and 7th decade (50.0%). 2) The most common symptom and physical finding were RUQ pain (83.9%) and RUQ tenderness (73.3%). 3) The most common positive laboratory finding was leukocytosis (40.4%). 4) Bile culture tests were done in 117 cases and were positive in 55 cases (47.0%). The most common bacteria was E.coli in 35 cases (29.9%). 5) The locations of stone were the GB in 146 cases (76.0%), the GB and CBD in 26 cases (13.5%), the GB and CBD and IHD in 14 cases (7.3%), the CBD only in 5 cases (2.6%), and the GB and IHD in 1 case (1.3%). 6) The incidence of retained stones was 15.1% (29 out of 192 cases) and the prevalent site was the CBD in 11 out of 29 cases (37.9%). 7) A complete choledochoscopic stone removal of retained stones was possible in 19 out of 25 cases, showing a 76.0% success rate. 8) The most common postoperative complication was wound infection (13.5%), and the postoperative mortality rate was 1.0%.